DESCRIPTION: (Applicant's Description) Women with a family history of breast cancer are at substantially increased risk for developing the disease themselves. The most effective method for decreasing the risk of breast cancer mortality in this population, is adherence to recommended guidelines for breast cancer screening. However, a significant percentage of these women do not adhere to these guidelines. Breast Cancer Risk Counseling (BCRC) is an intervention designed to improve screening adherence among this high risk population. However, BCRC does not address the psychological distress that is often present among women at risk for breast cancer. In fact, BCRC may actually lead to increased distress in this population. Psychological distress has been shown to be a barrier to breast cancer screening adherence. Thus, to maximize the effectiveness of BCRC, psychological distress should be reduced. Therefore, the goal of the proposed research program is to decrease distress, and improve adherence to breast cancer screening regimens among women with a family history of breast cancer. I will test an intervention based on the medical genetics counseling model and behavioral research on distress reduction. Randomized clinical trials will be used to evaluate the impact of BCRC in combination with exposure treatment. Pre-counseling psychosocial and demographic profiles will be used to identify individuals who are most and least likely to benefit from the interventions. This information could be used, in subsequent research, to tailor BCRC to the needs of the individual. The training program that I have proposed will complement my research program. Specifically, the training will strengthen my background in epidemiology, genetics, tumor biology, and preventive oncology. With the rapid advances in these fields, it is increasingly important to have at least a basic understanding of these disciplines. This award will allow me to obtain the training and experience necessary to complement my background as a clinical psychologist. By strengthening my background, I can develop a stronger research program through collaborations with researchers from a wide array of disciplines. This will enable me to conduct research at the intersection of behavioral, epidemiological, and biological science.